Doctoring & Healthcare

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Chemicals In Macaroni And Cheese Explained

If you’re a parent whose child loves macaroni and cheese (and truly, it’s the rare child who doesn’t), you’ve most likely seen the NYT media blitz on chemicals found in popular, boxed mac-n-cheese brands sold in grocery stores. I’m going to break it down quick and simple. Here we go….

  1. The chemical detected in the mac and cheese are called phthalates. Phthalates aren’t an added ingredient that companies are purposely using in their products. This isn’t an artificial ingredient, per se. It also isn’t something you avoid in your food when buying organic foods.
  2. Phthalates are chemical toxins that are used to make rigid plastics more flexible and less breakable. These plastics are used in processing plants and conveyor systems that our food and other ingredients travel THROUGH while being preserved and packaged. The phthalates can then leak from the plastics (tubing, conveyor belts, machinery) INTO our food or ingredients.
  3. Research links phthalates to possible genital abnormalities at birth and disruption of hormones, learning disabilities, and behavioral problems. Phthalate exposures during pregnancy can cause changes in estrogen and testosterone levels in fetuses. There isn’t a known “safe” amount of phthalates for our diets. So when we can reduce our exposure to them, we should.
  4. Almost all dairy products you consume contain phthalates. So it’s not just the mac-n-cheese that’s exposing us to phthalates. Milk, cheese, cottage cheese, string cheese, ice cream and other foods…any milk product contains them. Phthalates piggyback into our food and are stored in fat. That’s one of the reasons it’s smarter to drink low-fat dairy products over high-fat ones.
  5. We don’t know yet which brands the report surveyed and this work wasn’t published in a peer-reviewed journal. Some media outlets are reporting Kraft was included but I was unable to unearth which brands and what levels were found. To be safe, I’d assume most macaroni and cheese prepared products contain some level of phthalates because they all require processing.
  6. Buying organic mac-n-cheese isn’t saving you from phthalate exposure. Remember anything that’s been processed through tubing or machinery can have phthalates. Phthalates can also leave plastic products in our house (plastic food containers, plastic dishware, plastic surfaces) and enter our food, especially when heated. So the less we use plastic to store or transport our food the better!
  7. We don’t actually know what level of phthalates are safe for consumption so as the science and understanding of the risks evolve it’s best to think on diminishing exposures.

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Reducing BPA and Phthalates in Your Everyday Life

Chemicals are a part of our environment in the modern world, of course, thanks to the conveniences afforded to us by farming, manufacturing, and industry. Every parent wants to reduce exposures for their children as they grow. No question that developing babies and children may be more vulnerable to the effects of toxins as their bodies and organs and minds form. There are 80,000 chemicals in commerce (yikes!) with 3,000 being high volume meaning they can be found ubiquitously in some of our lives. There is no way to completely avoid them, but there are ways to reduce exposure to specific chemicals you’ve likely heard about, like bisphenol A (BPA) and phthalates and other pesticides and toxins found around your community.

Four quick tips for reducing toxins in your home below.

My colleague (from way back in residency), Dr. Sheela Sathyanarayana is an expert in understanding the effects of chemicals on developing and growing babies and children. She joined me for two podcasts to discuss chemical exposure, what the effects are and how you can reduce your family’s exposure. Dr. Sathyanarayana is a pediatrician at Seattle Children’s Hospital and a pediatric environmental health scientist at Seattle Children’s Research Institute. Her research focuses on exposures to endocrine disrupting chemicals such as phthalates and BPA and their impact on reproductive development.

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International Women’s Day: Boys, Listen Up

Happy International Women’s Day!

I’m squarely in mid-life, 42 years old, a mom to two, no longer a “young” doctor or young entrepreneur or young voice. Perhaps because of that, I’m starting to see things differently when it comes to raising boys and girls to support equality.

I’m a feminist. I think that means I don’t want gender/sex to get in the way of any individual. I was raised with a mom and dad who didn’t present a world of possibilities different for me than the one they presented for my brother. At least not that I could see. I’ve been mentored, supported, encouraged, and nurtured as a woman in the workplace, and a mother in my community, by female mentors like my mom and my advisor in college (a professor of psychology who studies gender), current and past colleagues, advisors, employers and co-workers, and dear friends. But more than ever before I’m feeling the profound support I’ve had from men in my life to be an active, striving-for-equal opportunity physician and advocate. In some ways it’s easier for me because I have the fortune to work as a physician in pediatrics, a field of physicians with a majority of women. In fact, 3/4 of the pediatric resident physicians in the US are women. It’s complicated though, so if interest consider reading, “The Good and Bad Statistics On Women In Medicine.”

However, now more than ever,

I’m starting to feel it isn’t my voice that will make things better for equal rights at large as time unfolds, it’s the voice of my boys.

Obviously this isn’t only about women supporting women. My strongest and perhaps most loyal advisors during my medical school education and during my residency training were both men who have helped me see and also helped me strategically carve out ways to get work done while also having children. I’d describe my residency mentor as one of the biggest feminists I’ve ever known. His feminism and support for me persist in my work and life. Exhibit A: I posted a photo in my pink hat on the day of the Women’s March in January and he was the first to comment saying, “I’m with you, Wendy.” He’s 40 years my senior and carries with him an elegant view of different ways to contribute to pediatric health care and also enjoy raising children of my own. Circa 2005, I vividly remember him drawing out, on a napkin, the different kind of career trajectories one could have in pediatrics and public health, describing them in terms of typical gender norms and roles and stating that I could do this — this career and life — any way that fit with my ethos, energy, passion, and tempo. I could adapt a “male” trajectory or a historically “female” one but that all models could work for all people.

Boys and men in my life do show me also how much they include me. Of course, I’ve felt discrimination, too. But this post isn’t about that. It’s about the BIG opportunity of NOW. Read full post »

Make A Customized Allergy Emergency Plan For Your Child

Let’s make things easier for children with life-threatening allergies. How we communicate what a child needs matters and can be essential to protect their safety but also reduce stress and anxiety for parents who worry. This week, experts in allergy and immunology at The American Academy of Pediatrics did us a favor and sorted through various allergy emergency plans living online and in doctors’ offices. Through experience with years of research on asthma action plans, the team created a Clinical Report that showcases a single, comprehensive and universal emergency plan to help ensure that parents and caregivers are ready to manage a life-threatening reaction called anaphylaxis. If you have a child or care for a child with food allergies, allergies to insects or a known risk for anaphylaxis, print one out, put it on the fridge and make sure your child’s school has it on file! The goal is to start having all families use the same form so schools, communities, sports teams and parents everywhere all get familiar.

 What Is Anaphylaxis?

  • Anaphylaxis is a potentially life-threatening, severe allergic reaction. I like how Food Allergy Research & Education defines it: “During anaphylaxis, allergic symptoms can affect several areas of the body and may threaten breathing and blood circulation. Food allergy is the most common cause of anaphylaxis, although several other allergens – insect stings, medications, or latex – are other potential triggers”.
  • Typically, children or adults with anaphylaxis have symptoms include itchy skin, hives, shortness of breath, swelling of lips/tongue, or wheezing. Some children vomit soon after eating a food they react to and some children get diarrhea.
  • Epinephrine should be given right away, in the thigh. If you ever feel you might need it, use it. Then call 911.

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5 Rules For Dosing Medicines For Colds And Ear Infections

In clinic the last couple of weeks I’ve been reviewing medicine doses with families for common over-the-counter (OTC) medicines repeatedly. It’s the time of year when goopy illness comes into our homes and is chased by fevers and aches and discomfort, screams and coughs, and overall gloom. Sometimes the goop turns to things that cause bigger pains (ear infections, strep throat & influenza) that have bigger solutions. But most of the time these gnarly colds just disrupt our lives and our holiday harmony and then go away thanks to the magic of our immune system. No question the holidays gather us together but those Whoville-Circles-of-Love also have us exchanging common colds like nobody’s business. We all wanna make the symptoms from colds go away, especially in our infants and toddlers who just can’t explain how they feel and seem to have their sleep disrupted in wildly unfortunate ways. Obviously, there aren’t a bunch of wonder drugs out there for these wintertime illnesses. But there are some lovely solutions that do help our children feel better (acetaminophen and ibuprofen — tah dah!)…

5 Things To Know When Using Medicine From The Drugstore:

  • Less Is More: My key takeaway for using OTC medicines is that often, you don’t need them. Don’t ever treat the thermometer. If your sweet human is bounding around the living room playing Twister and she feels warm to touch and you then confirm she has a fever with her sniffles (the thermometer reads 101.7 degrees) you don’t need to reach for acetaminophen. Keep her hydrated, have her cover her cough (yes, please!), make sure she gets rest so her body can do the dirty work of clearing out the infection. The acetaminophen should be used when she’s achy, not feeling well, or not wanting to be herself because of overall yuckiness. Treat your child, not the thermometer.
  • Pain Medicines For Ear Infections: Without question the most important medicine for most ear infections are the OTC medicines (acetaminophen and ibuprofen around the clock for the first 48 hours of an ear infection). After age 2 year, most children won’t need antibiotics — and most can avoid them and their side effects — if given time to heal. But the best bridge to getting there is making sure you take away the pain from those infections. More information about when to treat ear infections with antibiotics here.
  • Cough and Cold Medicines Only For School-Age: I think parents to infants and toddlers are desperate for solutions when their babes are unwell because of the profound amount of disruption a nasty cold virus brings to their life. Anyone who blows off the degree of ick of a 17 month-old with a bad cold and cough who isn’t sleeping nor eating and is coughing and choking and vomiting hasn’t parented one in a while. But quick reminder that not only are cough and cold meds not helpful in young children, they can be dangerous. Reach for a teaspoon of HONEY before anything in the medicine cabinet (as long as your little one is over 12 months of age). Research from 2007 found that honey has been found to help reduce nighttime cough better than OTC remedies.
  • Dosing Device: This time of year all sorts of people want to “baby” your baby. Grandma, Cousin Judy, whoever. Make sure someone isn’t dosing the medicines with the kitchen spoon. Use the dosing device that comes with the bottle of medicine always.
  • Weight Over Age Dosing: Always dose medicine by weight not age in young children. Here’s a dosing chart for acetaminophen and ibuprofen that includes doses for children under age 2 years. Here’s another version of acetaminophen and ibuprofen dosing that is easily downloadable! Print it out, keep it in the kitchen cabinet where you store your medicines. Call your pediatrician’s office if ever concern about how and when to dose. Those are never silly calls. Even if some jerky, tired, on-call provider makes you feel that way (I’m sorry if someone does). But it’s true, those are never silly calls if you’re confused or unsure.

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Empathy And Compassion For Transgender and Gender Non-conforming Children and Teens

gender-bathroomI saw this bathroom sign in my sons’ school a week ago. Talk about inclusion. I’m not only pleased that my boys are being exposed to open inclusion, I’m delighted they are getting the message that they can be whoever they are at home and at school. NO question in my mind the data proves if a child, teen or adult has questions about their gender their life is at risk for being harder. This is manifest in the high rates of anxiety and depression, bullying and ridicule, and feelings of isolation in those who are gender non-conforming and transgender. This is only estimated to be about 1% of the population (numbers are imprecise as many people hide this challenge) but how we all support those who question their gender matters for us all, the 99% of us who don’t have this challenge.

We must have compassion and empathy for children and teens who are transgender and gender non-conforming. We must accept children and teens and their families, and we can connect children and families who struggle with resources (below).

Children Are Born With Gender, Parenting Has Little To Do With It

  • Research shows that gender is established at birth. That means children are often born knowing if they are a boy or a girl irregardless of their sex (the chromosomes/genes that determine their body’s appearance and sexual characteristics). Sometimes children know this early, sometimes later in life.
  • Research shows that there is no evidence that parenting is responsible for a child having a different gender than their sex. Meaning — parents don’t have control, with their actions, over their child’s gender. They can’t change a child’s gender.
  • Research shows that children are less likely to end their life when they have challenges with their gender identity if they are accepted by their families. This means children who grow up in homes who accept them are less likely to suffer. Maybe a no-duh, but it’s something all parents should know.

This is complicated stuff, of course, and isn’t the same for all children and teens. Some children question their gender early in life (as early as preschool years) and will traverse childhood knowing they are transgender while other teens may find out at the onset of puberty that something isn’t quite right. Some children or teens just don’t identify with one gender or another (gender non-conforming). When they question this, we want to make sure they get what they need.

The most important message is that we must be open to what children express, connect children, teens and families with resources they need, and be aware of the risks for suffering in children who question their gender. Thankfully, there are lots of people to help and resources. Seattle Children’s Hospital now offers a specific clinic to support transgender and gender non-conforming children and teens (age 8-21 years). Experts and staff provide support for puberty blocking (stopping onset of pubertal development) or hormone therapy (hormones to have body characteristics match gender). They can also support conversations and planning for those who want to transition.

Statistics & Risks For Transgender Children And Teens

  • Transgender population is hard to define, probably less than 1% of adolescents
  • All gender non-conforming are at increased risk for bullying, anxiety, depression & suicide
  • 71% of transgender people said they hid their gender or gender transition to try to avoid discrimination

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Community and A Conference

21091855984_fc2bb18bd0_kI feel so much gratitude every day. I feel it for near cliche reasons (my sweet babies, good health, shelter, opportunity to make change, perspective that seeing the world has afforded me, and the freedom we have living here in a democratic society). Sometimes gratitude overwhelms me. And unsurprisingly that’s typically true on the most challenging days of life; I don’t see and feel and smell my gratitude on the easy days as well as I do on the days when life taxes and feels uncertain. I sense the gratitude housed in me most when I’m leaning on those around me, when I cry or when I’m worried or lack control in a situation. And the reason is this: my gratitude is greatest for the people in my life and seems to swell when I feel a sense of belonging. For being alive, for being a part of something greater than myself, and for the luxury of being suspended, taught, and caught just in time by the net of those who have me. Who trust in me and in themselves that we have the courage to live with intention, compassion, and empathy and that we can dent the universe. Supportive communities change everything…

My work here at Seattle Children’s in building digital tools, partnering in the design of curriculum created by patients, and nurturing parent-to-parent support with digital technology is influenced wildly by my net of community, my witness to suffering, and of course, my own experiences of when communication fails in the health space.

Like a lot of people, I feel I have the most incredible friends and I do feel I have the most supportive community of co-workers, patients, colleagues, advisors, and entrepreneurs who nurture in me an ongoing will to keep trying out new things in the health space. Most of the people in my community and on “my team” are as passionate and desperate to see change as I am…

We all have a team. Most of us have multiple, of course. Sometimes we define team with our families, a group at work solving a unifying problem, or by the outlines of communities from childhood or other stages in life. Social networks have woven some of these teams into daily networks we historically couldn’t have had. Thank goodness that with networks, texts, social channels, cellular phones, and other intuitive technology we typically never have to be far from those who surround us.

My good friend Susannah Fox is the one who long ago said, “Community is Your Superpower.” She began to proclaim this after fastidious work to understand and describe some of early research in peer-to-peer health care while doing research at Pew Research Center and now works in government to serve patients around this country at large. But her point and her wisdom extends to every corner of of our lives. The wild power that comes from insight and expertise from those who are like us. Not just emotionally but with information, resource, and tactics to solve life’s vexing problems, together.

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I mention all this because tomorrow around 4am I’m leaving my family in the dark to head to the airport to attend the Medicine X conference in Palo Alto. I’m joining dear friends, expert patients, entrepreneurs, nurses, executives, physicians, and artists as we gather to examine the opportunity of emerging technology to enhance our lives, solve health problems, hone solutions, and inspire diligence to making health care better. At Medicine X the patient voice is louder than at any other medical conference I’ve attended around the world. But more than anything as I ready to attend, I think of my visit as a return to a web of people and ideas that pour fuel into the center of me to keep thinking of ways to make change faster. Read full post »

Online Easy Access To Immunization Records

The digital health world recently took a step in the right direction when it comes to supporting access to your health care information. You can now be in charge of both your own and your family’s immunizations records in several states through a tool and online resource called MyIR (think “my immunization registry”). You can register yourself and your dependents and access to your official, consolidated immunization records on any device, any time. How great is that? No more calling your doctor’s office and asking them to fax your records over. Waiting for snail mail to deliver a copy is a thing of the past. For procrastinators with school paperwork, this is for YOU! With back to school rapidly approaching, now is the time to get your children up to date on their vaccines. And a great time for you to have unfettered access to the records.
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Read The Label And Know What Is In OTC Medicines

Quick reminders as we tidy our lives at the beginning of the school year. With little ones and children all heading back to school, we know it’s time to buckle down and get ready for the shift in schedules and in illness that comes with onslaught of viruses that come with preschoolers and elementary-aged kids back in the classroom. Before the fall is upon us, it’s a great time to really learn how to read the drug label and learn the ingredients, why or if it’s safe for a child the ages of your kids, why the inactive ingredients matter, and organize the cupboard! In some ways it’s combination medicines that make me worry the most — so this is a quick review on what you can do to feel confident when dosing and using OTC medications at home with your family.

Reading Over The Counter Labels & Dosing Liquid And Children’s Medicine:

1. Read the label.  Plain and simple get in the habit of always reading it as we don’t want to forget to make sure we really know what ingredients we’re giving and why. No question that sometimes we use medicines to “cure” children of illnesses, infections, or deficits (prescription antibiotics, anti-infectives, chemotherapy) but most OTC medicines only treat symptoms our children experience from infections or injuries. That makes them less necessary, although sometimes wildly helpful and soothing. Treating pain and discomfort is of course a priority for all parents when our children are uncomfortable! Consequently, we want to use OTC when they earnestly help and match the correct medicine with the symptom we’re targeting…the label can help.

reading labels 2

2. Know the ingredients — watch out for double dosing! So many products out there have combination medications. Many medicines for cough and cold will combine medicines for fever with medicines for mucus with medicines for cough. Some medicines combine medicines for allergy symptoms with medicine for fever. You might inadvertently be giving your child a second dose of acetaminophen (AKA “Tylenol”) when using a combination medicine without knowing it. Expert toxicology and pediatric emergency room friend, Dr. Suzan Mazor reminds, “that sneaky acetaminophen shows up in all sorts of combination medicines” so watch out! If you’re dosing acetaminophen for fever make sure you’re not double dosing if you’re also treating other symptoms with medicine.

3. The syringe or dosing cup -KEEP IT! Keep the dosing devices that comes with the OTC medicine you buy (use a rubber band as needed to attach it to the bottle)! No question that it is confusing to dose medicines based on weight. In the past, data finds that 98% of liquid OTC medications for children have inconsistencies, excess information, or confusing dosing instructions — thankfully this is changing and there is national push to have pediatricians write and explain doses only in milliliters or milligrams as opposed to dosing and explaining in “teaspoons” and “ounces.” As we work to standardize this there will still be some confusion. Read full post »

No Nasal Flu Vaccine This Year: Flu Shot For All Over 6 Months

Summer vacation has just started and it feels like the mild 2015-2016 flu season just ended. Here we are already hearing about new recommendations for the 2016-2017 season. Big news in the media today about flu vaccine: recommendations to only offer the shot (and no nasal flu spray) to improve children’s and public protection from the vaccine. Hundreds of children in the US die each year from influenza. We know the best way to protect against complications from influenza is to have families immunized. Flu vaccine is an every-year, essential vaccine as the strains included in the vaccine shift each year based on the types of flu predicted to spread across North America.

Recommendations For Pediatricians And Family Practitioners: Only Flu Shot For Families

Yesterday The American Academy of Pediatrics (AAP) endorsed the Advisory Committee on Immunization Practices (ACIP) recommendations to AVOID use of flu mist vaccine this coming flu season.  The Centers for Disease Control (CDC) will review the recommendations shortly; if CDC accepts the recommendation it will become official US policy.

We all want choice with vaccines and the nasal spray was a great option and a safe one. It was particularly effective during the 2009 H1N1 pandemic flu season and has been safe and very well received (no poke!) by families ever since for children over the age of 2. However, data from the past three years have found that it has been less effective in protecting children and their families from the most common strains of flu circulating (more below).

The nasal flu spray vaccine is still licensed and still safe. Because of recent data, this year to improve protection, ACIP is recommending only using the injected flu shot because it is far more effective at protecting against the strains of flu expected to arrive in the US.

That means a needle and quick poke for our kids. I talked to the TODAY Show about the recommendations this morning. I also talked with influenza and vaccine experts. Read full post »